Abstract
BackgroundDuring the last decade carbapenem-resistant Acinetobacter baumannii (CRAB) became hyper-endemic in hospitals due to difficult to control spreading. Our aim is to identify risk factors for nosocomial rectal CRAB colonization in an endemic hospital.MethodsA retrospective matched case–control study (ratio 1:2) with a prospective inclusion of cases and concurrent selection of controls was conducted from January 2017 to December 2018 in a tertiary-care hospital. Universal active surveillance for CRAB was implemented. Univariate and multivariate logistic regression was carried out using a stepwise selection method to compare prognostic factors between cases and controls. A sub-analysis was carried out according to the type of department.ResultsForty-five cases with nosocomial rectal CRAB colonization and 90 controls were included. One hundred and two (75%) patients were hospitalized in medical departments. At multivariable analysis significant risk factors associated with CRAB colonization were: use of permanent devices (OR 10.15, 95% CI 2.27–45.39; P = 0.002), mechanical ventilation (OR 40.01, 95% CI 4.05–395.1; P = 0.002), urinary catheters (OR 4.9, 95% CI 1.52–16.19; P = 0.008), McCabe score (OR 5.45, 95% CI 1.87–15.89; P = 0.002), length of stay (OR 1.03, 95% CI 1.01–1.05; P = 0.002), carbapenem use (OR 5.39, 95% CI 1.14–25.44; P = 0.033). The sub-analysis showed that patients admitted to different departments had different risk factors. In geriatric department a fatal disease and a longer hospital stay represented significant risk factors both in univariate and multivariate analysis, while in internal medicine department the use of permanent devices, current antibiotic therapy and antibiotic polytherapy represented significant risk factors for CRAB at the univariate analysis, also confirmed in multivariate analysis.ConclusionsOur data suggest that active surveillance for rectal CRAB colonization should be addressed to patients with an unfavourable prognosis, longer hospitalizations and carriers of multiple devices. To counter CRAB spreading in endemic settings, clinicians must limit the use of carbapenems, and reinforce interventions aimed at proper use of devices.
Highlights
During the last decade carbapenem-resistant Acinetobacter baumannii (CRAB) became hyper-endemic in hospitals due to difficult to control spreading
Meschiari et al Antimicrob Resist Infect Control (2021) 10:69 in endemic settings, clinicians must limit the use of carbapenems, and reinforce interventions aimed at proper use of devices
An intensive care units (ICUs) admission during hospitalization increased the risk of acquiring a rectal colonization with CRAB in hospital by 3.2 times, while patients transferred from a long-term health care facilities (LTHCFs) had a 16 time higher risk of nosocomial rectal CRAB colonization compared to patients living at home
Summary
During the last decade carbapenem-resistant Acinetobacter baumannii (CRAB) became hyper-endemic in hospitals due to difficult to control spreading. Several studies have been carried out worldwide with the aim of identifying risk factors for colonization and infection with A. baumannii, in particular focusing on CRAB [16,17,18,19]. Most of these studies were retrospective and conducted during CRAB outbreaks. The most common outcome was risk factors for CRAB infection and subsequent mortality These heterogeneous studies conducted in different epidemiological situations had methodological limitations mainly due to different selection criteria between cases and controls, and did not allow conclusive findings [1, 20, 23, 24]. This study aims to identify the main risk factors associated with rectal CRAB nosocomial colonization in a CRABendemic acute care facility
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